On April 13, 2021, America’s Physician Groups (APG) and the APG Direct Contracting Coalition (Coalition), submitted a letter to Elizabeth Fowler, Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMMI), “strongly urging” her to reopen the portal for applications to the Global and Professional Direct Contracting Model (GPDC). The letter asks for the portal to be reopened to accept new applicants for a January 1, 2022, start date.
The letter was sent in response to an April 8, 2021, memo issued by CMMI that indicated it would no longer accept applications beyond the initial April 1, 2021, cohort. This means that the second cohort, other than those who deferred from an Implementation Period of first performance year applications, will be halted. This will deprive many of the organizations who signed onto the letter from participating in the program as planned for January 1, 2022. Many of those organizations had already made substantial preparations and invested significant resources to meet the participation requirements. The decision also hurts patients by denying them better healthcare through these new payment models.
APG and the Coalition called the decision a “serious blow to the progress of the movement toward value-based care, perhaps the best hope for bringing higher quality and more affordable healthcare to all Americans.” APG and the Coalition believe that Direct Contracting represents the goal of a capitated payment model supported by quality improvement incentives, as envisioned by the Affordable Care Act, and that closing the applications for GPDC and curtailing Direct Contracting would “do a major disservice to the county, the providers that have worked hard to make it succeed, and to the Medicare beneficiaries that depend upon it.”
APG and the Coalition mention their support of the Biden Administration’s efforts to expand coverage but note that expanding coverage does not lower costs nor improve the quality of care – the only “known and proven way” to lower costs and improve quality is to bring value into the delivery system. By allowing organizations to change to a value-based payment system, healthcare costs are reduced, the patient experience is elevated, and the health of populations can be improved quicker.
“We are disappointed in CMMI’s decision to stop accepting applications,” said APG President and CEO Don Crane. “APG and the Coalition members believe that these risk-based Direct Contracting models represent the culmination of years of effort building risk-based models and to curtail them now appears to be a major step backward.”
APG established the Direct Contracting Coalition to help both current and potential participants in these risk-based models to exchange information and share best practices so that they can be successful. Co-chaired by Gary Jacobs, Executive Director of the Village MD Center for Public Policy, and Rushika Fernandopulle, MD, CEO of Iora Health, participation in the Coalition is open to any Direct Contracting-qualified organization.